MEDICARE: CARDIOVASCULAR CONSULTANTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	1724	OK

General Provider Information

NPI Number	:	1528152899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR CONSULTANTS INC

Provider Business Mailing Address
First Line	:	5555 E 71 STREET
Second Line	:	SUITE 7200
City	:	TULSA
State	:	OK
Zip	:	74136-6544
Country	:	US
Telephone Number	:	918-496-1907
Fax Number	:	918-496-8437

Provider Business Practice Location Address
First Line	:	5555 E 71 STREET
Second Line	:	SUITE 7200
City	:	TULSA
State	:	OK
Zip	:	74136-6544
Country	:	US
Telephone Number	:	918-496-1907
Fax Number	:	918-496-8437

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	GREGORY JAN MCWILLIAMS
Credential	:	DO
Telephone Number	:	918-496-1907

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/01/2008

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